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The efficacy of echocardiographic criterions for the diagnosis of carditis in acute rheumatic fever

Published online by Cambridge University Press:  01 December 2008

Ishwarappa B. Vijayalakshmi ,
Rajan O. Vishnuprabhu ,
Narasimhan Chitra ,
Ravindra Rajasri  and
Thejoor V. Anuradha
Ishwarappa B. Vijayalakshmi*
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Rajan O. Vishnuprabhu
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Narasimhan Chitra
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Ravindra Rajasri
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Thejoor V. Anuradha
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
*
Correspondence to: Dr. Ishwarappa B. Vijayalakshmi, MD, DM (Card), FICC, FIAMS, FIAE, FICP, FCSI, Professor of Pediatric Cardiology, Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology. Res: ‘Aditi’ 44 A, V Main road, Vijayanagar II stage, Bangalore-560040, Karnataka, India. Tel: 91 80 2330 2031, Mobile No: 094484940984; Fax: 91 80 2297 7236; E-mail: dr_vj@hotmail.com
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Abstract

Background

There is a great need for echocardiographic criterions for accurate diagnosis of carditis in acute rheumatic fever.

Aim

To test the efficacy of proposed echocardiographic criterions for the diagnosis of carditis.

Materials and methods

We studied 333 patients suspected of having acute rheumatic fever, undertaking detailed clinical examination, laboratory tests and meticulous echocardiography in each case. We used previously established echocardiographic criterions for the diagnosis of carditis and subclinical valvitis. In 220 cases (66.06%), both the echo criterions, and the Jones’ criterions, gave positive results. In 52 cases (15.61%), we found evidence of subclinical carditis, in that clinically no murmur was heard, meaning the Jones’ criterions were negative, but the echocardiographic evaluation was positive. In 4 patients clinically diagnosed as having carditis, the Jones’ criterions were positive, but echocardiographic evaluation showed them to have congenitally malformed hearts. In another 57 cases (17.11%), the Jones’ criterions were negative, as were the results of echocardiographic evaluation. These patients were taken as control subjects. On this basis, the echocardiographic criterions had sensitivity of 81% and specificity of 93%.

Conclusion

Using our echocardiographic criterions, it is possible to make a precise diagnosis of carditis or subclinical valvitis. Hence, echocardiography should, in future, be included as a major criterion in the Jones’ system.

Keywords

Jones criterionssubclinicalvalvitis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 6 , December 2008 , pp. 586 - 592
Copyright
Copyright © Cambridge University Press 2008

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References

1.Sanyal, SK, Berry, AM, Duggal, S, Hooja, V, Ghosh, S. Sequelae of the initial attack of acute rheumatic fever in children from north India. A prospective 5-year follow-up study. Circulation 1982; 65: 375–379.CrossRefGoogle ScholarPubMed
2.Jones, TD. Diagnosis of rheumatic fever. JAMA 1944; 126: 481–484.CrossRefGoogle Scholar
3.Report of the Adhoc Committee on Rheumatic Fever and Congenital Heart Disease of American Heart Association: Jones Criteria (Revised) for guidance in the diagnosis of rheumatic fever. Circulation 1965; 32: 664–668.CrossRefGoogle Scholar
4.Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association. Jones Criteria (Revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 70: 204A–208A.Google Scholar
5.Special writing group of the Committee on Rheumatic fever, Endocarditis and Kawasaki disease of the Council of Cardiovascular disease in the young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever: Jones criteria: 1992 update. JAMA 1992; 268: 2069–2073.CrossRefGoogle Scholar
6.Narula, J, Chandrasekhar, Y, Rahimtoola, S. Diagnosis of active rheumatic carditis. The echoes of change. Circulation 1999; 100: 1576–1581.CrossRefGoogle ScholarPubMed
7.Vijayalakshmi, IB, Mithravinda, J, Deva, AN. The role of echocardiography in diagnosing carditis in the setting of acute rheumatic fever. Cardiol Young 2005; 15: 583–588.CrossRefGoogle ScholarPubMed
8.Vijayalakshmi, IB. Acute Rheumatic fever: Role of Echo Doppler in Indian context. In: Manoria, PC (ed). Echocardiography Update. Volume I – Valvular Heart Disease. Jainan offset, Bhopal, 2002, pp 3–9.Google Scholar
9.Albert, DA, Harel, L, Karrison, T. The Treatment of rheumatic carditis: a review and meta-analysis. Medicine (Baltimore) 1995; 74: 1–12.CrossRefGoogle ScholarPubMed
10. Acute Rheumatic Fever. In: Park, MK (ed). Pediatric Cardiology for Practitioners, 5th edition.Mosby, Philadelphia, 2007, p 383.Google Scholar
11.Ferrieri, P. Jones Criteria Working Group. Proceedings of the Jones Criteria Workshop. Circulation 2002; 106: 2521–2523.CrossRefGoogle Scholar
12.Zoghbi, WA, Enriquez-Sarano, M, Foster, E, et al. Recommendations for Evaluation of the Severity of Native Valvular Regurgitation with Two-dimensional and Doppler Echocardiography. J Am Soc Echocardiogr 2003; 16: 777–802.CrossRefGoogle ScholarPubMed
13.Strasser, T, Dondog, N, El Kholy, A, et al. The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project. Bull WHO 1981; 59: 285–294.Google ScholarPubMed
14.Cotrim, C, Macedo, AJ, Duarte, J, Lima, M. The echocardiogram in the first attack of rheumatic fever in childhood. Rev Port Cardiol 1994; 13: 563,581–586.Google ScholarPubMed
15.Wilson, NJ, Neutze, JM. Echocardiographic diagnosis of sub clinical carditis in acute rheumatic fever. Int J Cardiol 1995; 50: 1–6.CrossRefGoogle Scholar
16.Wilson, NJ, Neutze, JM, Voss, LM, Lennon, DR, Ameratunga, RV. Colour Doppler demonstration of pathological valve regurgitation should be accepted as evidence of carditis in acute rheumatic fever. New Zealand Medical Journal 1995; 108: 200. Also in: New Zealand Medical Journal 1998; 111 Suppl: No 1067:10.Google Scholar
17.Abernethy, M, Bass, N, Sharpe, N, et al. Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever. Aust N Z J Med 1994; 24: 530–535.CrossRefGoogle ScholarPubMed
18.Tani, LY, Veasy, LG, Minich, LL, Shaddy, RE. Rheumatic fever in children younger than 5 years: is the presentation different? Pediatrics 2003; 112: 1065–1068.CrossRefGoogle ScholarPubMed
19.Kaplan, EL. Pathogenesis of acute rheumatic fever and rheumatic heart disease: evasive after half a century of clinical, epidemiological and laboratory investigation. Heart 2005; 91: 3–4.CrossRefGoogle ScholarPubMed
20. Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease in Australia. http://www.heartfoundation.org.au/document/NHF/PP-590_Diagnosis-Management_ARF-RHD_Evidence-Based%20Review_Sep06Update_FINAL.pdfGoogle Scholar
21. The New Zealand Guidelines: Guidelines for Rheumatic Fever 1: Diagnosis, Management and Secondary Prevention. http://www.heartfoundation.org.nz/files/Rheumatic%20fever%20guideline%201.pdfGoogle Scholar